Is a selfless caregiver really best for the patient?

As a psychologist at University of Colorado Cancer Center, Tim Sannes, PhD, runs a support group for caregivers of patients with cancer. Often, he sees caregivers so focused on helping their loved ones that they forget or neglect to take care of themselves.

“It’s admirable to put the patient’s needs ahead of their own, but the question is whether caregiving at the caregiver’s expense is really the best way to help the patient?” says Sannes, who co-founded the support group with Elissa Kolva, PhD.

Answering this question has been the primary focus of one of Sannes’ mentors, Mark L. Laudenslager, PhD, professor in the CU School of Medicine Department of Psychiatry. From many angles over many years, Laudenslager and others have shown that caregiver and patient wellbeing tend to go hand-in-hand. But what is the nature of this relationship? It makes sense that a patient’s wellbeing could boost a caregiver’s wellbeing (when a patient does well, it’s easier on the caregiver). It also makes sense that caregivers and patients may share factors of lifestyle, coping, and personality that could lead to a shared level of wellbeing.

Laudenslager and Sannes have been studying an intriguing third possibility, namely that a caregiver’s wellbeing could directly influence a patient’s wellbeing.

Rather than depending only on reports of attitudes and emotions surrounding cancer, caregiving, and treatment, the group tries to use more objective measures of caregiver and patient wellbeing. For example, a recent study asked if a caregiver’s quality of sleep (as measured by self-report and also by a wearable device) in the lead-up to bone marrow transplant is related to the time that it takes for transplanted stem cells to engraft in patients.

“One of the most important patient outcomes after stem cell transplant is how fast patients engraft – how quickly do these new cells take root in a patient’s body. We looked at caregiver sleep, time to engraftment, and controlled for a host of other variables,” Sannes says. “It turns out that caregivers with better sleep were associated with patients who engrafted more quickly after transplant.”

The study, published in the journal Cancer Nursing, measured sleep and engraftment in 148 caregiver/patient pairs to show that a caregiver who needed less time to fall asleep, and who spent less time awake after falling asleep, significantly predicted shorter time to patient engraftment. Earlier work has shown that sleep quality is a strong proxy for wellbeing. And in this case, a caregiver’s wellbeing as measured by sleep was associated with measurable, physical benefits to the patient – and with stem cells transplant, time to engraftment is an incredibly important outcome.

“We’re not saying that if you improve caregiver sleep, patients will do better. What we show is that caregiver and patient wellbeing is related. If we know one, we may be able to predict the other,” Sannes says.

The group’s ongoing work hopes to discover if interventions designed to boost caregiver wellbeing could, in fact, boost patient outcomes.

“Caregivers aren’t surprised when we talk to them about the need to take care of themselves. But we’re still learning the best ways to encourage self-care under these demanding situations,” Sannes says. “Caregivers are often willing to go to great lengths to help their loved ones. But it turns out that sometimes the best thing a caregiver can do for the patient is to take care of themselves.”